USMLE Step 1 was Totally Unlike Anything I'd Seen Before

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Baltar

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Hi All,

I took my test yesterday. Going in to the exam I was cautiously optmistic about my performance. I felt I had improved a great deal over my study period. I had made it through and notecarded FA, I had access to three different Q banks (UWorld, Kaplan, and Rx) and was performing satisfactory, and I had taken four NBME practice exams.

Form 6 200 three months out
CBSSE 250 two months out
Form 7 260 one week out
Form 13 271 four days out
Note: above scores are given in step 1 three digit equivalent.

But the exam experience was altogether disheartening. I don't know if I was one of the unlucky ones cursed with an abnormally hard test form or if my nerves got to me. But the test was unlike anything I had seen before -- it was different from the CBSSA practice forms and totally dissimilar from any q bank. The exam was difficult, the timing seemed different (I felt I had ample time on practice exams), and experimental questions weren't at all discernable as people said they would be. After my exam I seriously doubt the existence of experimental questions.

I guess I was hoping that someone would echo my experience. I am hoping I am not the only person who went in there with a good attitude and left feeling totally defeated.
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I've seen a lot of people beat themselves up. They're the ones who do well. You probably did a lot better than you thought if you put the hard work in.

Congratulations on being finished and thank you for sharing your experience.
 
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I took the exam early this week and also felt the exam was more difficult than most of my prep. I took NBME 12, 13, and 16 with scores between 245-260. NBME 16 was VERY close to the real thing in terms of style, length, and difficulty, so I was not necessarily surprised by what I encountered on the actual exam.
 
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Ionian said:
Said the account with 1 post.

It's called spreading the fear.

You won't get to me brah.
Click to expand...

I have no intention to spread fear. I only have one post because I joined sdn today to share my experience with others and vice versa.
 
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Step 1 is unlike anything anyone has seen before by definition, no one sees the test before they take it.
witzelsucht said:
So Baltar what would you have done differently in terms of prep? Goljan? Robbins?
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It's unlikely anyone getting >260s on practice tests would do anything differently.

Even if you thought to yourself you're doing well enough, to go start studying random research/genetics 'low yield' material, subsequent dropped scores in practices tests would scare people right back to UWorld/FA.

We don't have any other resources to prepare for the random stuff that gets thrown at us. Sometimes you just have to accept it, and know it doesn't really matter, because everyone will get it wrong too, and youll still end up on top for having nailed down the basics.

In summary, miss the hard ones? Who cares.
Miss the easy ones? You're screwed.
 
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witzelsucht said:
So Baltar what would you have done differently in terms of prep? Goljan? Robbins?
Click to expand...

I can only speak based on my experiance (the themes I picked up on in my form). I found it to be pretty heavy on physiology. I would spend a lot of time on that. As far as path goes, I don't recall any path or pharm, for that matter, that was not in FA. The level of detail though that one is required to know pathology and integrate that knowledge is far beyond the scope of FA. I would recommend Goljan for quick review but Robbin's for in depth review. Another thing is the histologic presentation of common lesions. I found that one of the things that threw me off the most -- common everyday path for which histo isn't normally discussed (or at least not at my school). Hope that helps.
 
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Baltar said:
I can only speak based on my experiance (the themes I picked up on in my form). I found it to be pretty heavy on physiology. I would spend a lot of time on that. As far as path goes, I don't recall any path or pharm, for that matter, that was not in FA. The level of detail though that one is required to know pathology and integrate that knowledge is far beyond the scope of FA. I would recommend Goljan for quick review but Robbin's for in depth review. Another thing is the histologic presentation of common lesions. I found that one of the things that threw me off the most -- common everyday path for which histo isn't normally discussed (or at least not at my school). Hope that helps.
Click to expand...


Going through all the images in webpath... is always on my list on things.... but its very very very far down there.
 
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I averaged 260+ on my practice tests. Step 1 was 40% gimmies, 20% fair and medium difficulty, 20% fair and hard difficulty, 20% what is this chit. The first 80% could be prepared for, the last 20% I have no idea how I'd prepare for it. Felt like I got a form that hit my weaknesses pretty well (multiple questions on penile innervation and half the micro q's were on parasites and whatnot). Predicted a 235-255 after the test, ended up with a 256. Some of the questions are going to take you off guard, just don't sweat it and do the best you can to prepare with the high yield sources that are available (FA, UW, pathoma). It's not like other medical students are going to have some mysterious advantage over you
 
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Took the exam last year and I think the biggest difference I've noticed between practice tests/World on the real deal is that you will feel MUCH more uncertain on the real exam. I noticed many questions would have at least one answer choice I'd NEVER heard of. For example, lets say you get a classic EKG question with irregular r-r interval, no p waves, etc. In addition to a-fib, one of the answer choices might be E) Gabor-Schlittenger Cardiomyopathy. So yes, you're 99% sure they're going for a-fib, but it's hard to shake that uncertainty that there was some finding on that EKG you were supposed to know that would make it E. This was a pretty constant thing throughout my exam and has remained so on shelf exams throughout 3rd year. The physio questions test the relationships of things that are not directly covered in First Aid and they'll often add some other thing you don't usually think about. For example, for some sort of calcium/vit D/PTH question, they may have all those arrows plus PO4 as well 25-OH Vit D. So yeah, you may have memorized the arrows for various conditions, but you probably never learned how 25-OH Vit D changes in those conditions. What they want you to do is think about the pathway and figure it out, but it still throws you for a loop because they took a question that should have been a sure thing and twist it enough that you're not 100% sure you nailed it.

This, to me, is the biggest reason people come out of the test feeling defeated yet end up doing really well, especially those who were scoring high beforehand. There's also a lot of leeway in the scoring. Positive I missed 30-40 questions and still scored >260. For those who haven't taken it it: trust your prep and try not to let the NBME mess with your head too much.
 
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@leonidis . I am going to take the test around July . what mid may changes? Can you elaborate please ? Thanks in advance 🙂
 
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operaman said:
. In addition to a-fib, one of the answer choices might be E) Gabor-Schlittenger Cardiomyopathy. So yes, you're 99% sure they're going for a-fib, but it's hard to shake that uncertainty that there was some finding on that EKG you were supposed to know that would make it E. .
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So you just ignore the unheard of answer choices and solve the question assuming they are trying to confuse you?
 
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BlueArc said:
So you just ignore the unheard of answer choices and solve the question assuming they are trying to confuse you?
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I always feel really hard pressed to choose the answer I've never heard of...unless I'm relatively certain all the other choices are wrong.
 
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operaman said:
Took the exam last year and I think the biggest difference I've noticed between practice tests/World on the real deal is that you will feel MUCH more uncertain on the real exam. I noticed many questions would have at least one answer choice I'd NEVER heard of. For example, lets say you get a classic EKG question with irregular r-r interval, no p waves, etc. In addition to a-fib, one of the answer choices might be E) Gabor-Schlittenger Cardiomyopathy. So yes, you're 99% sure they're going for a-fib, but it's hard to shake that uncertainty that there was some finding on that EKG you were supposed to know that would make it E. This was a pretty constant thing throughout my exam and has remained so on shelf exams throughout 3rd year. The physio questions test the relationships of things that are not directly covered in First Aid and they'll often add some other thing you don't usually think about. For example, for some sort of calcium/vit D/PTH question, they may have all those arrows plus PO4 as well 25-OH Vit D. So yeah, you may have memorized the arrows for various conditions, but you probably never learned how 25-OH Vit D changes in those conditions. What they want you to do is think about the pathway and figure it out, but it still throws you for a loop because they took a question that should have been a sure thing and twist it enough that you're not 100% sure you nailed it.

This, to me, is the biggest reason people come out of the test feeling defeated yet end up doing really well, especially those who were scoring high beforehand. There's also a lot of leeway in the scoring. Positive I missed 30-40 questions and still scored >260. For those who haven't taken it it: trust your prep and try not to let the NBME mess with your head too much.
Click to expand...

fun fact, this is the first time in history the words Gabor-Schlittenger Cardiomyopathy has ever been written.
 
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Guys you want to know why the usmle feels worse than the NBMEs?

Take an NBME. And right before it shows your score close the window. Now set a timer for a few hours and go do something else, knowing after that set amount of time you will see your result. Start trying to remember the questions you were uncertain about. You feel that? That's why you think it feels worse. The uncertainty and fear you feel for a couple seconds after an nbme/qbank block you feel for about 4 weeks after the real thing.
 
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Brain Bucket said:
Nah dude. Everyone I've heard from in the past month has said the same thing. The tune being sung during Dec/Jan was very different.
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I took mine in the end of October. Could it have seriously changed so drastically? I also have a friend who wrote his in end January and he got a really good score as well.

Even when I wrote it, sure the questions weren't seen before but that's to be expected right? The concepts stay that same, but they go after it in a different way.
 
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Brain Bucket said:
Yeah, the Dec/Jan/Feb tests went fine. I've seen 1 fail, 1 very low, and 1 245 from early March. All people who were set to score > 220 at least. The 245 averaged 260+s on NBMEs. n=3, so there's no need to panic, but I'm concerned.
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I'm about 9 weeks out from mine. I remember going back to look at the 2013 thread during last summer and people saying the same thing. The way I look at it, there's only so much I can do. I'll stick to the best resources bust my ass and hope for the best.
 
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Ionian said:
Step 1 is unlike anything anyone has seen before by definition, no one sees the test before they take it.


It's unlikely anyone getting >260s on practice tests would do anything differently.

Even if you thought to yourself you're doing well enough, to go start studying random research/genetics 'low yield' material, subsequent dropped scores in practices tests would scare people right back to UWorld/FA.

We don't have any other resources to prepare for the random stuff that gets thrown at us. Sometimes you just have to accept it, and know it doesn't really matter, because everyone will get it wrong too, and you'll still end up on top for having nailed down the basics.

In summary, miss the hard ones? Who cares. Miss the easy ones? You're screwed.
Click to expand...

BINGO.
 
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DermViser said:
I agree. It's virtually unGoogleable.
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😱
wtf.jpg
 
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Brain Bucket said:
Yeah, the Dec/Jan/Feb tests went fine. I've seen 1 fail, 1 very low, and 1 245 from early March. All people who were set to score > 220 at least. The 245 averaged 260+s on NBMEs. n=3, so there's no need to panic, but I'm concerned.
Click to expand...
I could swear people were saying the same thing last year. Come to think of it, I'm pretty sure the year I took the mcat it suddenly got super hard and weird and everyone was bombing it, too.
 
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Donald Juan said:
I could swear people were saying the same thing last year. Come to think of it, I'm pretty sure the year I took the mcat it suddenly got super hard and weird and everyone was bombing it, too.
Click to expand...

These hard forms seem to be earlier in the year don't they? Looking at all the "x year scores and experience threads" seems around april/may/june most people are just posting up their scores of how well they did. But jan-march theres a lot of wtfs.

Probably just because more people are taking it around april-june, and less people who thought it sucked are in a mood to post about it.
 
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This post is very interesting to read about because I took my Step 1 a couple days ago and I felt like it was almost identical to NBMEs and UWorld. In fact some questions were almost word for word. Sure there was stuff I had to guess on, as per usual practice tests, but overall I felt like I was marking less questions than on usual. Doing all of the NBMEs seemed to help. I don't want to jinx anything, but I was expecting it to be a lot worse. I thought it would be more like NBME #16, with long stems and tricky choices but it seemed more strait forward.... hopefully this isn't a bad sign...as I've heard most people come out of the test feeling like crap....
 
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I hope so....I'm starting to doubt myself now but it's hard to even remember any questions and I don't want to go and look them up either....
I know theres nothing I can do now. Just wondering if there are people out there that left the test feeling ok and ended up doing ok....
 
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Yea My friend just took a month ago and she got a 240. Its not the exam its how you handle it . They say its 70% mental ..I'm sure did just fine!
 
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Hi all,
Iam new to this forum and really need help, my exam is in 10 days. My nbme scores are nbme 12 -400 (1.5 months back), nbme 11 15 days back-230, Uwsa 2-250 5 days back, nbme 16 yesterday- 230 again ,Iam depressed since I haven't improved since my last nbme,my target was a 245 but I seriously don't know if I should postpone my exam. Thanks in advance.
 
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Exam fever said:
Hi all,
Iam new to this forum and really need help, my exam is in 10 days. My nbme scores are nbme 12 -400 (1.5 months back), nbme 11 15 days back-230, Uwsa 2-250 5 days back, nbme 16 yesterday- 230 again ,Iam depressed since I haven't improved since my last nbme,my target was a 245 but I seriously don't know if I should postpone my exam. Thanks in advance.
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hey thats great! don't postpone, you have reached your peak and you will reach your goal If you are confident and focused in the exam. Trust me. Gluck
 
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Haha yeah I just needed to make up a condition that I was sure nobody had heard of to make my point. Obviously the real exam will come up with something that actually exists, like Tako-tsubo cardiomyopathy or something like that. I think when faced with these questions, you have to go with what you KNOW to be true even if there's an answer you've never heard of. I did have another question where the right answer was the condition I'd never heard of, but they gave enough history and labs and physical exam findings to definitively rule out the other choices which was likely the very point that question was trying to test.
 
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Hi Baltar,
I've had the exam same, maybe more mortifying experience, just took it recently. Didnt have as great NBME scores as you. Would be nice to know what you got finally, so as to have an estimate.


Baltar said:
Hi All,

I took my test yesterday. Going in to the exam I was cautiously optmistic about my performance. I felt I had improved a great deal over my study period. I had made it through and notecarded FA, I had access to three different Q banks (UWorld, Kaplan, and Rx) and was performing satisfactory, and I had taken four NBME practice exams.

Form 6 200 three months out
CBSSE 250 two months out
Form 7 260 one week out
Form 13 271 four days out
Note: above scores are given in step 1 three digit equivalent.

But the exam experience was altogether disheartening. I don't know if I was one of the unlucky ones cursed with an abnormally hard test form or if my nerves got to me. But the test was unlike anything I had seen before -- it was different from the CBSSA practice forms and totally dissimilar from any q bank. The exam was difficult, the timing seemed different (I felt I had ample time on practice exams), and experimental questions weren't at all discernable as people said they would be. After my exam I seriously doubt the existence of experimental questions.

I guess I was hoping that someone would echo my experience. I am hoping I am not the only person who went in there with a good attitude and left feeling totally defeated.
Click to expand...
 
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001100010010011 said:
I've seen a lot of people beat themselves up. They're the ones who do well. You probably did a lot better than you thought if you put the hard work in.

Congratulations on being finished and thank you for sharing your experience.
Click to expand...

Please don't encourage this kind of attitude. People will start thinking that beating themselves up will lead to a better score. No, it makes no sense. But it will happen. People should be encouraged to relax.
 
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Yea i felt the same way, and felt I got owned on a form that was pretty much unlike anything I had seen in mid-may, with a large proportion different from FA, UWorld, USMLErx imo. Everyone thought I was trolling in the other thread (not sure what exactly I would be accomplishing by doing that, lol). I doubted others that said they felt like crap after the test, and thought it wouldn't apply to me, but here I am.

Anyhow, to be fair, I don't think I failed and I probably will have a good score by any measure. The feeling that you're genuinely going to score 10-15 pts below your NBME average majorly sucks though, I will say. Not horrible, but not where you're at and not where you've busted your @#& to get to for months. I know the mantra is most people score +/-5 pts of NBME average, but that step 1 exam was challenging compared to what I was used to, and am pretty sure I missed too many to hit my averages.

I'll try and update with my score when I get it, in case it helps anyone reading this that is in the same predicament

UPDATE: 250-260. Made more mistakes than I can count on both hands. Stop stressing!
 
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